Provider Demographics
NPI:1558581272
Name:LUCIANO PARKER, JOANNA SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:SUSAN
Last Name:LUCIANO PARKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 TRIFECTA PL STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLES TOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25414-4958
Mailing Address - Country:US
Mailing Address - Phone:304-725-0508
Mailing Address - Fax:304-728-8761
Practice Address - Street 1:46 TRIFECTA PL STE 102
Practice Address - Street 2:
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414-4958
Practice Address - Country:US
Practice Address - Phone:304-725-0508
Practice Address - Fax:304-728-8761
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV37081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV06586Medicaid